摘要
背景胰岛素瘤是常见的功能性胰腺神经内分泌肿瘤,症状复杂多变,误诊率高,定位诊断及最佳治疗是胰岛素瘤诊治过程中的重大挑战。目的总结胰岛素瘤的诊治经验。方法回顾性分析2009—2019年于承德医学院附属医院接受外科手术治疗的15例胰岛素瘤患者的临床资料,总结其临床表现、定性诊断、定位诊断、手术方式、术后情况及随访资料。结果15例患者中单发13例,多发2例,其中1例合并多发内分泌肿瘤1型(MEN-1)。15例患者均有Whipple三联征表现,胰岛素释放指数(IRI/G)均>0.3。15例患者均行经腹超声检查,无阳性发现;行胰腺强化CT检查,阳性14例,阴性者进一步行MRI检查发现病灶。15例患者均行手术治疗,9例行肿瘤摘除术,5例行胰体尾切除术(4例腹腔镜手术,1例开腹手术),MEN-1患者行保留幽门的胰十二指肠切除术(PPPD)+胰尾肿瘤摘除术,术后病理均为良性胰岛素瘤。术后临床相关性胰瘘(B/C级)4例,无围术期死亡患者。术后患者血糖均恢复正常且随访未见肿瘤复发及新发糖尿病患者。结论Whipple三联征结合IRI/G是术前定性诊断的主要依据。胰腺增强CT及MRI是术前一线定位诊断手段,内镜超声(EUS)是重要的补充手段。手术切除是目前的一线治疗方案,符合条件者首选肿瘤局部切除以充分保留胰腺功能。
Background Insulinoma is a common functional pancreatic neuroendocrine tumor,with high possibility of being misdiagnosed due to complex and changeable symptoms.Making a topical diagnosis and providing patients with the optimal treatment are major challenges in the diagnosis and treatment of insulinoma.Objective To give a summary of our experience of diagnosis and treatment of insulinoma.Methods A retrospective design was used.Participants were 15 insulinoma patients who received surgical treatment in Affiliated Hospital of Chengde Medical University from 2009 to 2019.Their clinical data(including clinical presentations,qualitative diagnosis,topical diagnosis,surgical approach,and postoperative conditions),and follow-up data were summarized.Results Thirteen patients had solitary insulinoma,2 patients had multiple insulinomas.One patient with multiple insulinomas also had multiple neuroendocrine tumor type 1(MEN-1).All cases showed Whipple's triad,with an insulin release index(IRI/G)greater than 0.3.All patients had negative results for transabdominal ultrasonography.Fourteen patients had positive results for enhanced pancreatic CT,and the other one with negative results was found with insulinoma by MRI.All patients underwent surgical resection,among whom 9 underwent insulinoma enucleation,5 underwent a distal pancreatectomy(4 used laparoscopic approach and 1 used open approach),the MEN-1 patient underwent pylorus-preserving pancreaticoduodenectomy(PPPD)plus distal pancreatectomy.All tumors were pathologically benign.There were 4 cases of postoperative clinically relevant pancreatic fistula(grade B/C),and there was no perioperative death.Hypoglycemia disappeared after resection in all cases,and no recurrence and new-onset diabetes were found in the follow-up.Conclusion Whipple's triad and IRI/G are the main evidence for qualitative diagnosis preoperatively.Contrast-enhanced CT and MRI of the pancreas are the first-line preoperative diagnostic methods,and endoscopic ultrasound is an important supplementary method.Surgical resection is the first-line treatment,and enucleation should be preferred for eligible patients in order to fully preserving pancreatic exocrine and endocrine functions.
作者
陈琳光
于爱军
张学军
卜春红
CHEN Linguang;YU Aijun;ZHANG Xuejun;BU Chunhong(Department of Hepatobiliary Surgery,Affiliated Hospital of Chengde Medical University,Chengde 067000,China;ICU,Affiliated Hospital of Chengde Medical University,Chengde 067000,China)
出处
《中国全科医学》
CAS
北大核心
2022年第29期3698-3701,共4页
Chinese General Practice
基金
河北省自然科学基金资助项目(H2021406047)
承德市科学技术研究与发展计划(202006A087)。
关键词
胰岛素瘤
多发性内分泌肿瘤1型
诊断
外科治疗
Insulinoma
Multiple endocrine neoplasia type-1
Diagnosis
Surgical procedures
